Nobody Asked Me, But I Will Tell You Anyhow

Dateline: June 20, 2018

By Jack Moscou


Health care is more than a human right, it is an absolute necessity.

When it comes to health care we have a tendency to break it down into mental health and physical well-being even when we think the mind and body are one.

Let me start by discussing our society’s mental health issues before segueing into physical health.

First, a few words about our  opioid “crisis.” Opioids are not the problem.  The problem is our American way of life which is patently bad for the health of tens of millions (if not more) of our fellow citizens.  It is a dog-eat-dog, me-first way of life that, while it produces “winners” who enjoy  an exceptional standard of living and all the perks that go with it, also produces countless numbers of losers with all the despair and heartache that go with “losing.”


David Smail, 1938 – 2014,  an English clinical psychologist and writer whose work focused on the damaging effects of an unequal society, wrote:

Hardly any of the ‘symptoms’ of psychological distress may correctly be seen as medical matters. The so-called psychiatric ‘disorders’ are nothing to do with faulty biology, nor indeed are they the outcome of individual moral weakness or other personal failing. They are the creation of the social world in which we live, and that world is structured by power.

     Social power may be defined as the means of obtaining security or advantage, and it will be exercised within any given society in a variety of forms: coercive (force), economic (money power) and ideological (the control of meaning). Power is the dynamic which keeps the social world in motion. It may be used for good or for ill.

     One cannot hope to understand the phenomena of psychological distress, nor begin to think what can be done about them, without an analysis of how power is distributed and exercised within society.

This is probably as good a refutation of those who blame the victim for their victimization as can be found. Failure to come to terms with Smail’s analysis guarantees that mental health problems will continue to proliferate through all sectors of our society no matter how much money and resources  we throw into helping people suffering from, as David Smail so aptly puts it, psychological distress.

We, whites, have been studying, writing, pontificating, about the causes of Black “pathology” ever since we kidnapped them, enslaved them, and persecuted them in ways large and small. No matter how clearly Blacks describe the racism they endure and the psychological distress it causes them we insist on ignoring Smail and keep looking for every reason other than  the social structure we have created.

To make the point by way of an imperfect analogy, when I was growing up I was told that homosexuality was caused by, among other things: the devil, smothering mothers, distant fathers, permissiveness, socialism, liberal democrats to name those I remember. I also remember calling people I didn’t like faggots ꟷ as early as when I was maybe six or seven and didn’t even know what the word meant.

What drives me crazy about this is during all that time gay people were saying nobody made them gay and they didn’t choose to be gay but that they were born that way. And the response  of everyone from bible believing fundamentalists to intellectuals  who studied sexuality was just because you’re gay doesn’t mean you know what caused it ꟷ we do, so there, that settles it.


Moving on from taking a look at our mental health problems and looking at our over-all health problems, let me quote Mark Twain, “The worst loneliness is not to be comfortable with yourself.”

I think that in a society that privileges people, not only materially but psychologically, who are white, hetero-sexual, rich and well-off, a successful professional or businessman (not quite so much if you are a successful professional or business woman) tall and with a chiseled muscular body if you are a man, slim and shapely with a well-developed bosom and backside to match if you are a woman, it is hard to be comfortable with yourself if you fall outside those parameters.

Throw in Marx’s concept of alienation as workers are removed from control over their work product, with little to no control over their working conditions, forced to sell, and be dependent upon, someone buying their labor, it shouldn’t be surprising to anyone that you wind up with an awful lot of people suffering from mental and physical “illness.”


As long as we have a social system (capitalism in America, but any system in which power is unequally shared) in which economic insecurity, just earning enough to scrape by, racism, sexism,  and a media (reflecting our culture)  that constantly traffics in lurid accounts of violence, gossipy, privacy invading sexual titillation stories, while downplaying serious socio-political questions, “illness” will be the norm.

I would argue that it is impossible to live in a dysfunctional society that breeds alienation and not be alienated from your own body.  A healthy body (and mind) requires a healthy society.

I grant you that creating a healthy society will not cure all mental and physical problems but I am willing to bet that fifty percent of those problems would disappear overnight.


I come back to the central theme that animates everything that I write:  until and unless we embrace a humanist philosophy all our efforts to ameliorate our dysfunctional society will prove to be merely band-aid exercises in futility.


To all those conservatives and bean counters who constantly invoke cost/effective ratios and the need for efficiency in our health care delivery system as the solution, I offer the following anecdote:

“An old guy in Miami Beach, shabbily dressed, goes to an expensive heart surgeon, who determines that the old man needs surgery. But since he is obviously poor, the surgeon says to him, “You know I am the most expensive surgeon in Miami Beach.” The old man says, “Fine.” The operation is a success. The doctor presents his bill and the old man says, “I’m a poor man, I can’t pay this.” The doctor reminds him, “I told you I’m the most expensive surgeon in Miami Beach,” to which the old man replies, “I know. But when it comes to my health, nothing is too good for me.”


I repeat myself, as long as we continue to be a sick society we will have people suffering “sickness.”


Jack Moscou is a co-founder of The Writers Collective. He has an extensive background in management training, strategic planning, and political consulting.  His commentary on political events was previously posted in  He is the author of Why Not Utopia: A Political Platform in Search of a Party.


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2 thoughts on “Nobody Asked Me, But I Will Tell You Anyhow”

  1. Smail’s definitions of the three forms of social power are beautiful and I had never heard them before. Especially wonderful is the idea of “ideological social power” and it’s brilliant definition as “control of meaning”. I can imagine nothing more powerful than control of meaning especially when it is backed by, and interwoven with, coercive and economic power. This whole article is amazingly incisive and concise and is a great summation of how social disfunction is generated and maintained here and throughout the world.

    I suggest that there is a hidden engine driving the forms of social power: Unbalanced centralized control of survival resources. In particular, control of water, energy, and food. Control those and you control your own fate. Therefore, the response to unbalanced social power is to redistribute it through taking local control of water, energy and food – an informal, spontaneous movement that is slowly but surely taking root and proliferating around the world.

    The far right hysterical fervor, and the existence of Donald Trump are symptoms of the desperate resistance to this growing correction of unequal power and influence by people and communities waking up to the injustice. We must organize and concentrate our efforts to enable communities to localize the production of energy, water and food (roughly in that order) to accelerate the positive effects.

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